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PubMed2005

Factors associated with academic success at Vienna Medical School: prospective survey.

AIM: To identify factors relating to students' success in the study of medicine at the Medical University of Vienna. In view of Austria's tradition of open access to higher education, which results large number of students, high dropout rate, long duration of studies, factors predicting success could be helpful for student counseling. METHODS: In a prospective study, 674 freshmen (50.8% of students enrolled that year) responded to a questionnaire on their sociodemographic data, family background, performance in school, economic situation, living conditions, social integration and health, learning capacity, motivations related to studies and future profession, attitudes, and the ability to cope with stress. We used the results of the compulsory test of knowledge after the first year as an outcome measure of their success. RESULTS: By comparing two extremes of academic success, very successful students and students who twice failed the challenging first-year exam, we were able to identify three factors relevant in predicting academic success: male sex, German as mother tongue, and good performance in secondary school. Moreover, there is evidence that maturity and intrinsic motivational structure are linked to superior academic performance. CONCLUSION: The results of this study differ from or even contradict the findings of previous retrospective studies in Austria. We suggest that a more thorough examination of the effect of gender should be undertaken in future studies. We also hope that our work will lead to the improvement in the efficiency of the German courses for foreign students. Our findings confirm the importance of success in secondary school, but also clearly indicate that it should not be the only criterion for university admission.

Achievement↗
PubMed1992

Origins and clinical relevance of child death review teams.

Interagency child death review teams have emerged in response to the increasing awareness of severe violence against children in the United States. Since 1978, when the first team originated in Los Angeles, Calif, child death review teams have been established across the nation. Approximately 100 million Americans or 40% of the nation's population now live in counties or states served by such teams; most have been formed since 1988. Multiagency child death review involves a systematic, multidisciplinary, and multiagency process to coordinate and integrate data and resources from coroners, law enforcement, courts, child protective services, and health care providers. This article provides an introduction to the unique factors and magnitude of suspicious child deaths, and to the concept and process of interagency child death review. Future expansion of this process should lead to more effective multiagency case management and prevention of future deaths and serious injuries to children from child abuse and neglect.

Adolescent↗
PubMed1991

[Functional properties of B-lymphocytes of patients with a B-cell variant of chronic lymphocytic leukemia and chronic glomerulonephritis].

The common features of the pathogenesis of chronic lymphocytic leukemia (CLL) and chronic glomerulonephritis (CGN) have been shown as a result of a comprehensive study of the functional properties of B cells. Both CLL and CGN are accompanied by the appearance and accumulation of different types of activated B cells characterized by high spontaneous proliferation and/or Ig secretion; or sensitivity to T cell growth and differentiation factors; or capacity for Ig secretion; in mitomycin C treated B cell cultures (i.e. without previous proliferation). The present data may be useful in the integral evaluation of B cell function in health and in immunopathologies (lymphoproliferative and autoimmune/immune complex diseases).

B-Lymphocytes↗
PubMed1998

Extensible markup language (XML) in health care: integration of structured reporting and decision support.

The Extensible Markup Language (XML) is a newly adopted Internet protocol for data interchange designed to bring the key features of the Standard Generalized Markup Language (SGML; ISO 8879:1986)--extensibility, complex structures, and validation--to the World Wide Web. In this paper, we describe an architecture that uses XML to mediate between disparate client-server systems for structured reporting and decision support.

Bayes Theorem↗
PubMed1996

Understanding hospital referrals to home health agencies.

Using resource dependency theory and transaction-cost economics theory, we examined the simultaneous effects of a vertical integration strategy and environmental complexity on home health agency (HHA) referrals by hospitals. Discharge data for calendar year 1990 from 61 Pennsylvania hospitals were analyzed. Using hospital ownership of home health agencies and urban versus rural location as the primary independent variables, a logistic regression model calculated the probability of HHA referral, after controlling for long-term care beds and patient characteristics. Results showed that HHA ownership was a significant predictor of home health referrals for both rural and urban hospitals, although the effect was greater for urban hospitals. These results suggest that hospitals are actively using referrals to home healthcare in response to environmental pressures. As these pressures increase, hospitals will benefit from tight linkages with home health providers.

Aged↗
PubMed2003

[Social support contribution to health and the adoption and maintenance of health behaviors].

Social support refers to the presence of individuals providing emotional or material resources. Its four components are: integration, structure, function, and quality. This article presents empirical and theoretical data, as well as criticism of studies which examine the relationship between social support, global health and cardiovascular health, also evaluating direct or moderating contributions to the adoption and maintenance of health behaviours in persons with cardiovascular disease. Concrete implications for nursing practice are reviewed.

Adaptation, Psychological↗
PubMed2005

Spatial-scale effects on relative importance of physical habitat predictors of stream health.

A common theme in recent landscape studies is the comparison of riparian and watershed land use as predictors of stream health. The objective of this study was to compare the performance of reach-scale habitat and remotely assessed watershed-scale habitat as predictors of stream health over varying spatial extents. Stream health was measured with scores on a fish index of biotic integrity (IBI) using data from 95 stream reaches in the Eastern Corn Belt Plain (ECBP) ecoregion of Indiana. Watersheds hierarchically nested within the ecoregion were used to regroup sampling locations to represent varying spatial extents. Reach habitat was represented by metrics of a qualitative habitat evaluation index, whereas watershed variables were represented by riparian forest, geomorphology, and hydrologic indices. The importance of reach- versus watershed-scale variables was measured by multiple regression model adjusted-R2 and best subset comparisons in the general linear statistical framework. Watershed models had adjusted-R2 ranging from 0.25 to 0.93 and reach models had adjusted-R2 ranging from 0.09 to 0.86. Better-fitting models were associated with smaller spatial extents. Watershed models explained about 15% more variation in IBI scores than reach models on average. Variety of surficial geology contributed to decline in model predictive power. Results should be interpreted bearing in mind that reach habitat was qualitatively measured and only fish assemblages were used to measure stream health. Riparian forest and length-slope (LS) factor were the most important watershed-scale variables and mostly positively correlated with IBI scores, whereas substrate and riffle-pool quality were the important reach-scale variables in the ECBP.

Agriculture↗
PubMed2006

Building an interoperable regional health information network today with IHE integration profiles.

One of the key challenges of architecting electronic record sharing solutions that are scalable and can provide acceptable performance is how to create a longitudinal record for a patient when the desired data will be stored in several distributed point-of-service systems. This paper will review the design and standards selection process that has been made by Integrating the Healthcare Enterprise, a multi-national collaborative of care providers and developers that analyzed a variety of approaches. In particular, the requirements, issues, and alternative solutions for scalable, standards-based data locating services supporting regional and national health information exchange solutions will be discussed. Guidance will be offered to architects of regional health information organizations to take advantage of this experience and leverage the IHE Technical Framework, its testing processes, and tools to accelerate their projects and facilitate the interfacing of EHR systems serving different care settings from different vendors or developers. The implementation experience in 2005-2006 of the IHE Integration Profile specifications supporting an interoperable RHIO solution among various EHR systems from more than 30 vendors will be analyzed, with key lessons summarized.

Computer Communication Networks↗
PubMed2004

Reexamining organizational configurations: an update, validation, and expansion of the taxonomy of health networks and systems.

OBJECTIVES: To (a) assess how the original cluster categories of hospital-led health networks and systems have changed over time; (b) identify any new patterns of cluster configurations; and (c) demonstrate how additional data can be used to refine and enhance the taxonomy measures. DATA SOURCES; 1994 and 1998 American Hospital Association (AHA) Annual Survey of Hospitals. STUDY DESIGN: As in the original taxonomy, separate cluster solutions are identified for health networks and health systems by applying three strategic/structural dimensions (differentiation, integration, and centralization) to three components of the health service/product continuum (hospital services, physician arrangements, and provider-based insurance activities). DATA EXTRACTION METHODS: Factor, cluster, and discriminant analyses are used to analyze the 1998 data. Descriptive and comparative methods are used to analyze the updated 1998 taxonomy relative to the original 1994 version. PRINCIPAL FINDINGS: The 1998 cluster categories are similar to the original taxonomy, however, they reveal some new organizational configurations. For the health networks, centralization of product/service lines is occurring more selectively than in the past. For the health systems, participation has grown in and dispersed across a more diverse set of decentralized organizational forms. For both networks and systems, the definition of centralization has changed over time. CONCLUSIONS: In its updated form, the taxonomy continues to provide policymakers and practitioners with a descriptive and contextual framework against which to assess organizational programs and policies. There is a need to continue to revisit the taxonomy from time to time because of the persistent evolution of the U.S. health care industry and the consequent shifting of organizational configurations in this arena. There is also value in continuing to move the taxonomy in the direction of refinement/expansion as new opportunities become available.

American Hospital Association↗
PubMedDate not supplied

The effects of cognitive-perceptual factors on health promotion behavior maintenance.

A causal model that examines the role of cognitive-perceptual factors (control over health, self-efficacy, and health status) in health-promoting behavior maintenance was tested using a sample of 1,339 women who participated in a two-wave national health survey. The sample was split to reserve half the data for an uncompromised validity test of the model. Initial tests of the causal model indicated that the model did not fit the data. A minimally modified model fit the observed covariance data and explained about one third of the variance in the health-promoting behaviors (self-actualization, health responsibility, exercise, and nutrition). Validation of the model with the uncompromised half of the data further supported the model. Although the cognitive-perceptual factors were an integral part of the model, their effects on particular health-promoting behaviors were small in magnitude and contributed little to the explanation of the specific health-promoting behaviors or their stability.

Adult↗
PubMed1998

Achieving standardization of health information in Canada by the year 2000.

As health reforms gain momentum in Canada, a critical need has been identified for the development of standardized health information across the continuum of health services. Although vast amounts of data are collected, deficiencies and gaps in current information systems seriously limit its effective use. As provinces and territories move toward more integrated health services systems, the necessity for a comprehensive and systematic analysis of health information requirements, and the development of requisite standards has never been greater. To begin addressing this need, the Canadian Institute for Health Information (CIHI) established a number of interrelated projects in 1995. This paper describes the goals of these projects, as well as the approach used to assess information needs across health services and to develop required standards.

Canada↗
PubMed2000

[Smoking, self-experienced health and social integration among adolescents].

BACKGROUND AND OBJECTIVE: In spite of increased preventive efforts against smoking in the Norwegian population, a substantial number of adolescents starts smoking. This study was meant to increase our understanding of smoking behaviour among adolescents by examining the relationship between subjective and emotional health and social integration on the one hand and smoking on the other. METHOD: The study was based on data from a cross-sectional survey of 828 students in upper secondary schools (91% of all students) in Førde carried out in 1997 (age group 16-19). Univariate and multivariate analyses were used to examine the relationship between smoking and relevant predictor variables. RESULTS: Self-assessed health, emotional and psychosomatic health were lower among smokers than non-smokers. Female students were also worse off concerning these health complaints. Smoking prevalence was three times higher among students attending vocational secondary schools compared to students attending college proparatory programmes. Smokers reported better social integration and intimacy with friends than did non-smokers. They also reported greater problems with intimacy with parents. CONCLUSION: In preventive work among adolescents, we have to be aware of an important ambiguity: Smoking is associated with reduced subjective and emotional health, but also with better social integration and intimacy with friends.

Adolescent↗
PubMed2006

Real-time and time-integrated PM2.5 and CO from prescribed burns in chipped and non-chipped plots: firefighter and community exposure and health implications.

In this study, smoke data were collected from two plots located on the Francis Marion National Forest in South Carolina during prescribed burns on 12 February 2003. One of the plots had been subjected to mechanical chipping, the other was not. This study is part of a larger investigation of fire behavior related to mechanical chipping, parts of which are presented elsewhere. The primary objective of the study reported herein was to measure PM(2.5) and CO exposures from prescribed burn smoke from a mechanically chipped vs. non-chipped site. Ground-level time-integrated PM(2.5) samplers (n=9/plot) were placed at a height of 1.5 m around the sampling plots on the downwind side separated by approximately 20 m. Elevated time-integrated PM(2.5) samplers (n=4/plot) were hung atop approximately 30 ft poles at positions within the interior of each of the plots. Real-time PM(2.5) and CO data were collected at downwind locations on the perimeter of each plot. Time-integrated perimeter 12-h PM(2.5) concentrations in the non-chipped plot (AVG 519.9 microg/m(3), SD 238.8 microg/m(3)) were significantly higher (1-tail P-value 0.01) than those at the chipped plot (AVG 198.1 microg/m(3), SD 71.6 microg/m(3)). Similarly, interior time-integrated 8-h PM(2.5) concentrations in the non-chipped plot (AVG 773.4 microg/m(3), SD 321.8 microg/m(3)) were moderately higher (1-tail P-value 0.06) than those at the chipped plot (AVG 460.3 microg/m(3), SD 147.3 microg/m(3)). Real-time PM(2.5) and CO data measured at a position in the chipped plot were uniformly lower than those observed at the same position in the non-chipped plot over the same time period. These results demonstrate that smoke exposures resulting from burned chipped plots are considerably lower than from burned non-chipped plots. These findings have potentially important implications for both firefighters working prescribed burnings at chipped vs. non-chipped sites, as well as nearby communities who may be impacted from smoke traveling downwind from these sights.

Air Pollutants↗
PubMed2006

Monitoring the integration of hospital information systems: How it may ensure and improve the quality of data.

Integration of hospital departmental information systems (HDIS) has become a common but difficult issue. In May 2003, the Department of Biostatistics and Medical Informatics implemented a Virtual Electronic Patient Record (VEPR) for the Hospital S. João (HSJ), a university hospital with over 1350 beds. The system integrates clinical data from 10 legacy HDIS plus the Hospital Administrative Database (HAD), aiming to deliver all patient information to health professionals. Currently, around 500 medical doctors use the system on a regular basis and the HSJ-VEPR retrieves an average of 3,000 new reports per day, in PDF or HTML formats. This paper describes and discusses the role of monitoring in the assurance and improvement of data quality. Three approaches were put in place: (a) monitoring the HSJ-VEPR concerning the frequency of clinical records retrieved from the DIS by checking if the daily number of reports sent by the HDIS fell in the normal range from similar week days; (b) monitoring inconsistencies in the patient's identification by cross-checking between HDIS and HAD; and (c) monitoring the integrity of clinical records delivered to medical doctors through the HSJ-VEPR by checking their digital signature. During 2005, the monitoring system detected 53 unusual frequency patterns of which 44 corresponded to real problems. Over a 6 months period, more than 400 alerts were generated concerning inconsistencies in the patient's identification found in laboratory reports. Nevertheless, a significant reduction in the number of these inconsistencies occurred - from 116 in July to 10 in December 2005--due to implementation of preventive measures by the DIS. Finally, report's integrity was checked each time the report was asked to be visualized i.e. in more than one hundred thousand times during a one year period. In conclusion, all information available in hospital information systems can and should be used to trigger alerts of malfunctions and inconsistencies, in order to improve data quality and ensure a better health care.

Hospital Information Systems↗
PubMed2026

Patterns of antimicrobial resistance genes in pathogens across One Health sectors in Ireland: an in silico approach.

As part of a rapid risk assessment, an in silico approach was used to detect antimicrobial resistance (AMR) in pathogenic isolates from humans, animals, and the environment. A total of 11,670 genomic data sets were retrieved from the NCBI Pathogen Detection system for Ireland, which represented 47 pathogenic species, including Salmonella enterica, Escherichia coli/Shigella spp., Staphylococcus aureus, Klebsiella pneumoniae, and Enterococcus faecium. Identifying the most critical pathogenic strains over time is essential, as these organisms significantly contribute to mortality, morbidity, and hospitalization. The analysis identified 799 antimicrobial resistance genes (ARGs), including their allelic diversity, 117 plasmid replicons, and 274 virulence factors. Several critical ARGs, particularly those conferring resistance to beta-lactams, aminoglycosides, quinolones, and colistin, were common across isolates originating from human, animal, and environmental sources, suggesting shared resistance profiles across One Health sectors. Klebsiella pneumoniae, E. coli/Shigella spp., S. enterica, and S. aureus were the dominant hosts of these ARGs and associated mobile genetic elements. Increasing resistance across major antibiotic classes aligned with trends reported across other European countries. This study provides a national-scale in silico comparison of AMR across pathogens and One Health sectors using publicly available genomic data. The findings help reinforce Ireland's AMR surveillance by showing which resistance genes are present and how they spread across critical pathogens in humans, animals, and the environment. These findings highlight the urgent need for improved antibiotic stewardship and integrated One Health surveillance to limit the emergence and spread of AMR.IMPORTANCEAntimicrobial resistance (AMR) is a growing threat to human, animal, and environmental health. This study used publicly available genomic data to identify antimicrobial resistance genes (ARGs) in key bacterial pathogens circulating in Ireland. By analyzing over 11,000 genomes from humans, animals, and the environment, we found that several dangerous resistance genes, including those against last-resort antibiotics, were widespread across different sources. The study highlights which bacteria and resistance genes are most critical and how they may spread between humans, animals, and the environment. These insights provide a national snapshot of AMR, supporting more effective monitoring and prevention strategies. By revealing patterns of resistance and modes of transmission, our findings underscore the importance of coordinated antibiotic stewardship and One Health approaches to slow the emergence and spread of resistant infections, protecting public health and ensuring antibiotics remain effective.

Humans↗
PubMed2005

Cross-institutional data exchange using the clinical document architecture (CDA).

PROBLEM: Although electronic communication of clinical data between various actors in the healthcare domain seems crucial for a cost-effective patient treatment, it is mostly restricted to paper based documents. In order to meet the growing need for improved data communication, it is necessary to overcome the barriers of software heterogeneity and lack of standards, especially in cross-institutional shared care communication. HL7's clinical document architecture (CDA) is a new and promising tool to exchange any clinical document. In this paper we show how CDA can be used to (1) share electronic discharge letters and other clinical data generated and stored in the hospitals electronic patient record (EPR) with general practitioners and (2) to transfer these clinical data to a personal electronic health record (EHR). The latter scenario is in routine use. Ease-of-use and data security and integrity were the main design principles in both scenarios. METHODS: Within the electronic patient record a data extraction and exporting mechanism has been built. For both scenarios appropriate data processing and transmission methods have been developed, and the receiving information systems have been prepared for the CDA based data input. RESULTS: Although there still remain technical and organizational issues to be solved, this is a promising method in order to enhance data exchange between hospital and primary care and to move towards an electronic patient record (EPR) and an electronic health record (EHR) crossing institutional borders. This paper describes the design and current implementation and discusses our experiences.

Germany↗
PubMed2003

U.S. Government statistics on the World Wide Web.

The U.S. Government produces and provides massive amounts of statistics. Government initiatives have made much of the statistical information emanating from its various federal agencies, departments, and offices digitally accessible on the Internet. Assisting users in locating specific statistics can be one of the most challenging duties librarians have. This article provides a guide to government sources that will help librarians locate health statistics for researchers, health professionals, health consumers, and others. Some selected sites may be an endpoint of the search, and others may offer a solid beginning to a complex answer. Links are also provided to gateway Web sites, where a search strategy utilizing some of the tips discovered while compiling this list can be used to help promote successful outcomes. As always, it is recommended to use evaluative criteria to assess information quality as well as integrity of the data.

Humans↗
PubMed2005

Knowledge, perceptions, and attitudes of advanced practice nursing students regarding medical genetics.

PURPOSE: To describe the current medical genetic knowledge and perceptions of graduate advanced practice nursing (advanced practice nurse [APN]/nurse practitioner and nurse anesthetist) students using survey data for future integration of genetic topics, principles, and healthcare issues into curriculum. DATA SOURCES: Survey data of APNs' perceived knowledge of genetics and a review of the literature from past research studies of students and current articles from professional journals and organizations. Web sites were those of the National Coalition of Health Professions for Education in Genetics and National Institutes of Health, Human Genome Research Institute; professional organizations; and the authors' professional, clinical, and educational experiences. CONCLUSIONS: Most APN students perceived they had minimum knowledge and prior training regarding medical genetics. There is a need to integrate genetic concepts, principles, and medical conditions into advanced practice nursing curriculum and to provide clinical experiences in genetic conditions across the life span and throughout the health and illness spectrum. APN students have positive attitudes toward integrating genetics into graduate curricula. Potential methods for program integration include readings, small group discussion, standardized patients, and role-play as measures to increase information. IMPLICATIONS FOR PRACTICE: The National Coalition for Health Profession Education in Genetics, the American Nursing Association, and the American College of Nursing Education have recommended integration of genetics knowledge and skills into routine health care to provide effective interventions for individuals and families. However, previous research and data from this study have revealed that many nurses have minimal training in genetics. Advanced practice nurses must be knowledgeable on genetic principles, topics, and the ethical, legal, and social implications related to medical genetics to increase the ability to diagnose, prevent, and treat diseases and to provide effective care for individuals and families.

Adult↗